Field of the Invention and Related Art. This invention is directed to the problems of arthroscopic surgery. More particularly, it facilitates the very difficult manipulation requirements of the patient""s joints during the arthroscopic surgery.
Illustrative of these difficulties are the manipulations needed to position the arthroscope for examination of all of the compartments of the knee. Such an examination often starts with insertion of the arthroscope through an anterolaterial or anteromedial portal to first examine the lateral or medial gutters. This examination is usually made with the knee being fully extended. Thereafter, the knee must be bent to permit examination of the notch and groove of the femur. Subsequently, varus and valgus forces are applied to the knee to open the medial and lateral joint lines to permit examination of the meniscus.
After examination, remedial repair of the meniscus, the ligaments and tendons may be necessary. Such repair imposes further demands upon the surgeon. For these repairs a surgical instrument is inserted through another portal and both of the surgeon""s hands are fully engaged. Similarly, his feet may be needed to actuate and control the speed of motorized instruments such as a shaver. These ambidextrous efforts often require the use of a nurse or surgical assistant to whom various requests for movement of the leg must be made. These requests are for various movements in terms of direction, degree and extent of movement of the extremity. One group of authors has described the problems:
Manipulation of the knee joint to open and close the various compartments of the knee is critical for adequate visualization of intra-articular structures and successful arthroscopic surgery. For the inexperienced arthroscopist, manipulating the arthroscope and instrument, as well as the knee to provide adequate exposure, can be overwhelming. Therefore, a surgical assistant is usually necessary during arthroscopy of the knee. The surgical assistant stands below the surgeon and manipulates the knee with either varus or valgus stresses in varying degrees of flexion and extension. The surgical assistant is also available to lend a hand when handheld instrumentation is being exchanged or more than two portals are being used.
Fu, Harner and Vince, Knee Surgery, V. 1, p. 550 (Williams and Wilkins, 1994).
The magnitude of these problems is emphasized by the fact that in excess of 400,000 arthroscopic knee surgeries are believed to take place annually within the U.S. Consequently, there are numerous surgeons facing the problem of manipulation daily and many are resorting to the cost and expense of a surgeon""s assistant.
The present invention is intended to facilitate these manipulations. In addition, it is intended to minimize or obviate the need for the surgical assistant, to provide more precise positioning of the entire limb, to open the joint further with accuracy while providing excellent control over the extent of the movement so as to minimize the danger of accidental slips with delicate instruments in very delicate spaces. In addition, the invention enables the surgeon to control the pressures exerted on the limb and possibly decrease the incidence of nerve palsies and collateral ligament damage associated with manipulation of the extremity.
Description of the Prior Art. To this inventor""s knowledge, the above quotation represents the today""s state of the art solution to manipulating the knee during arthroscopic surgery. Such is the only prior method known to him or printed in medical books and journals.
This invention is an attaching device for affixing a patient""s limb to the surgeon""s body for manipulation of the limb and its associated joint or intra-articular structure to facilitate arthroscopic examination or surgery. The invention includes an fastener on the limb and a cooperating fastener carried by the surgeon""s body. The fasteners can take many forms. A preferred form is a pressure sensitive fastener such as an adhesive and a bonding surface, the Dual Lock(and fabric fastening system of the 3M Company of St. Paul, Minnesota, etc. More particularly, the preferred pressure sensitive fasteners are those of the traditional hook and loop fasteners such as those sold under the trademark Smart Touch(trademark) by YKK of America and under the Velcro(copyright) brand sold by Velcro, USA of Manchester, N.H. Either the hook or loop is formed on a flexible strip that can be wrapped around the limb of the patient with the fastener exposed while the other cooperating fastener is the surface of a surgeon""s gown or apron. With the cooperating fasteners being-joined by pressure, the surgeon can easily affix the limb to his gown or apron. In addition, such can be quickly and easily unfastened and affixed to the other side of the apron or gown to facilitate joint manipulation for examination on the opposite side of the joint. In one preferred embodiment, the flexible strip is formed of an elastic fastening material that can be tightly wrapped around the patient""s limb for two distinct benefits. The first benefit is a simplistic method of fastening or attaching the limb to the physician""s gown or apron for purposes of manipulation, control and stability during the surgery. The second synergistic benefit is that of eliminating the requirement for Coban(copyright) or Ace(copyright) wrap and the utilization of the elastic fastening material to avoid pooling of blood and fluids within the patient""s leg during the surgery.
Accordingly, the objectives of this invention are to provide, among other things,
1) a fastening system for affixing a patient""s limb to a surgeon""s body to enable the surgeon to accurately manipulate and position the limb""s associated joint to facilitate arthroscopic examination and surgery;
2) a pressure sensitive fastening system for affixing a patient""s limb to a surgeon""s body and to facilitate release and refastening of the limb to a different portion of the surgeon""s body for further manipulation;
3) a garment apparatus for arthroscopic examinations that will elimimate the need for a surgeon""s assistant and simultaneously facilitate accurate position of the limb and the opening of an intra-articular structure for insertion and examination of the structure;
4) a garment wrap for arthroscopic examinations that will simultaneously serve to prevent the pooling of liquid and blood in a patient""s limb and as a fastener device for attaching the garment apparatus and the patient""s limb to the surgeon""s body;
5) an elastic garment wrap for a patient""s limb that will simultaneously serve to prevent or reduce the pooling of liquid and blood in the patient""s limb and as a fastener device for affixing the limb to a fixture or a surgeon""s body, thereby eliminating the need for Coban or Ace wrappings which performs the single function of preventing pooling of blood;
6) a low cost adhesive device for affixing a patient""s limb to a surgeon""s body for manipulation thereof; and
7) a simplified arthroscopic surgery method avoids confusion and miscommunications between the surgeon and the assistant as to the angle, height or magnitude of the necessary movement of the limb;
8) elimination or minimization of the need for surgeons assistant to manipulate a patient""s limb during surgery;
9) an arthroscopic surgical method and system for decreasing the incidence of nerve palsies and collateral ligament damage as well as damage to other elements of the joint,
10) a low cost wrap for simultaneously preventing the pooling of blood and for fastening a patient""s limb to a fixture, support of a surgeon""s body; and
11) a low cost garment wrap combination for simultaneously preventing the pooling of blood in a patient""s limb, for positioning and affixing said limb to a support, fixture or surgeon""s garment and for facilitating arthroscopic surgical examinations.